Permit 1!
,, ,'r + "5 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00179
13125 SW Hall Blvd., Ti Date Issued: 06/11/2010
Tl'rAR and OR 97223 503.639.4174 � 9
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: Lot: 0
Project: Spec space
Project Description:
Owner:. FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 5 ea Sink 06/04/2010 $125.10
PHONE: 1 ea Water Heater 06/04/2010 $37.52
1 12% State Surcharge - 06/04/2010 $19.51
Plumbing
Contractor:
FOSTER PLUMBING INC
10100 SW EVERGREEN CT
WILSONVILLE, OR 97070
PHONE: 503 - 951 =2050
FAX: 503- 482 -5310
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $182.13
Required Items and Reports (Conditions)
This,permit is issued subject to the regulations contained in the Tigard Municipal Code, State'of OR, Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permitwill expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION- Oregon:,law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forthin OAR 952-001-0010 through OAR 952-0014)100. You may obtain a copy of the rules
or direct questions ttoo O by calling 503.246.6699 or 1.800:332.2344.
Issued By: / J J / ■di. �/.—/' ermittee Signature: O/tl /ti/ L / C i
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application ' 1, - 500 , / 4 -- .
Building Fixtures �� Received
V�' , Oa o , l i , U Q
�^
L ...1 City of Tigard �C Date /By: (f' L...1 /0 �� n[ , I r A / V 71
Permit No.: ) PJ O�
001
n 1 31 25 SW Hall Blvd., Tigard, OR 972 �4'�O Y' /
Phone: 50 3.639.4171 Fax: 503.598.1960 a
Plan Review �,`
w\ Other Permit No.:6 (4 PP'0 I U - 00) U 1,
\`, D ate /B y:
Inspection Line: 503.639.4175 J� Page 2 for
TIG -.-:'
RD ` GP+� Ready /By: Ju ris: ® S S
,.. :. , ,� _ ,.,; Internet: www.tigard-or.gov 1 O � 'c l , 1s , 0 Date Read /B ed/Method: /� Supplemental Information
TYPE OF WORK C . - � _ FEE* SCHEDULE .
❑ New construction ❑ Dt Ition F or special information use checklist
Description IC,',RT Total
N Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
'CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1 - and 2- family dwelling W Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
- JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I ' - c 2 1/49 St P� �. . L 14.3v � Catch basin or area drain 18.76
p� 2 / Drywell, leach line, or trench drain 18.76
City /State /ZIP:
1 0 k 09-- l 1.2.2 J Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: f em 4-6- 54- r i_ C `� ►s 1 04 J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
• - Storm sewer (no. linear ft.: ) Page 2
. - Water service (no. linear ft.: _) Page 2
Subdivision: Lot no - Fixture or item:
Fax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
1 ,+ F t /V)91 C ( Avum i r �L1A - ^ V I ` N vnlo`h'1 Dishwasher 25.02
Dn I y d O Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER . I - ❑ TENANT Expansion tank 12.51
Name:
Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
S 1as. /t )
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
. Water closet 25.02
CONTRACTOR.
Water heater 1 37.52 'y 7.t` }.
Business name: i-0S..4.4_ 1 p Ik of t,-.)-1.1. 1 01, Water piping/DWV 56.29
Address: I 0 i 0. �, ' �� J 1, vt?r C - -I , Other: 25.02
r'fr .v�
City /State /ZIP: �i l s �ti I ; 11 it og q 73'7 J
Subtotal
Phone: (j ,3) 9 5 j .. ,� S - L) Fax: ( j:)$) tf i‘,2 - 1 J Minimum permit fee: $72.50 1 r
Plumbing Lic. no.: p6 `� 5:5 /, f )t Plan review (25% of permit fee)
CCB Lic.:
i '; '� / � /1 y State surcharge (12% of permit fee)
1 q,si
Authorized signature: (j _ a 141.-
TOTAL PERMIT FEE . 1 l3
Print name: Ir F ` � ; Date: 6./ 3/ /3 This permit application expires if a permit is not obtained within 1 0 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service ard.
Sine Ic Need iv be Pw r ,0
Oro{ - 6 I.;s;sc.tcti/C-e --
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
S te.Utillities Qty Fee'(ea . ;Tool ,'Square Footage: aPermit °Fee. -. •
Footing drain - I" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm &Rain Drain - 1st 100' 62.54 r`'Valuat Permit F ee xi ,fic'�
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10',000.00 $72.50 for the first $5,000.00 and $1.52 for
Qty: Fee (ea): • Total each additional $100.00 or fraction thereof, to
Other )f�npeet>to.'ns Fees and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00 /hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes" Plaln'Rev><ew for Pluinbi g Instailat>tt tis
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantitx (Fixtur Performed ❑ Any new commercial building with water service 2" and
Fni ure Type Replace, greater, except systems designed and stamped by licensed
" Previous Capped Ad Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or,RiserDiagrm
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-a"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial 5 *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes plumbing permit can be issued.
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
1: \Building \Permits \PLMF - PermitApp.doc 2